Republic of the Philippines

Department of Health – Regional Health Office I

URDANETA DISTRICT HOSPITAL

Urdaneta City, Pangasinan

Certificate No. ______________

Date January 20, 2021

MEDICO-LEGAL CERTIFICATE

TO WHOM IT MAY CONCERN:

This is to certify that LYSELLE MARI P. RAMBAC, 14 years old, with

residence at Brgy. Poblacion, Urdaneta City, Pangasinan, was examined and

treated/confined in this hospital on January 20, 2021 with the following diagnosis:

= Normal external genitalia:

(-) hematoma (-) erosions
ymenal ring (+) superficial healed lacerated wound
at 3 & 9 o’clock positions.
IE: admits 1 finger with ease, cervix closed, uterus
Not enlarged (-) adnexal mass & tenderness.
(-) bleeding.
x-x-x-x-x-x-x-x-x-x

And would need medical attention for days __________ barring complications.

ELEANOR BAÑAGA, MD REMEDIOS FRANCIA

Attending Physician Medical Records Officer I

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